Risk Factors for Pancreatic Fistula after Stapled Gland Transection

2011 ◽  
Vol 77 (8) ◽  
pp. 965-970 ◽  
Author(s):  
Preeti D. Subhedar ◽  
Sameer H. Patel ◽  
Peter J. Kneuertz ◽  
Shishir K. Maithel ◽  
Charles A. Staley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Staple Line ◽  
Univariate Analysis ◽  
Fistula Formation ◽  
Staple Line Reinforcement ◽  
Mesh Reinforcement ◽  
Included Patient ◽  
Pancreatic Transection ◽  
Clinically Significant

The objective of this study was to identify risk factors for pancreatic fistula (PF) after stapled transection in distal pancreatectomy (DP). Patients undergoing DP using a stapler for transection between 2005 and 2009 were identified from a pancreatic resection database. Variables examined included patient and tumor characteristics, staple size, and the use of mesh reinforcement. Univariate and multivariate regression analyses were performed to identify risk factors for postoperative PF. One hundred forty-nine had stapled transection, and of these, 25 (17%) had mesh reinforcement. The overall morbidity and mortality rates were 28 per cent and less than 1 per cent; 34 (23%) were diabetic. The rate of clinically significant PF was 14 per cent. On univariate analysis, diabetes ( P = 0.04), a firm pancreas ( P = 0.03), use of mesh staple line reinforcement ( P = 0.02), use of a 4.1-mm staple cartridge ( P = 0.01), and blood loss greater than 100 mL ( P = 0.01) were associated with higher pancreatic fistula rates. On multivariate analysis, only the presence of diabetes (OR, 4.17; 95% CI, 1.1-15.3; P = 0.03) and the use of a 4.1-mm cartridge (OR, 8.57; 95% CI, 1.2-60.2; P = 0.03) were independently associated with pancreatic fistula formation. Stapled pancreatic transection provides an acceptable PF rate after DP. Diabetes and staple size influence PF rates. In our experience, use of mesh staple line reinforcement did not reduce the incidence of PF after stapled transection.

Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections

2009 ◽  
Vol 75 (10) ◽  
pp. 954-957 ◽  
Author(s):  
Eduardo A. Guzman ◽  
Rebecca A Nelson ◽  
Joseph Kim ◽  
Alessio Pigazzi ◽  
Vijay Trisal ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Staple Line ◽  
Parenchymal Transection ◽  
Staple Line Reinforcement ◽  
Distal Pancreatic Resection ◽  
Pancreatic Resections ◽  
Clinicopathologic Factors ◽  
Pancreatic Fistulas ◽  
Definition Of

Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy

2007 ◽  
Vol 14 (6) ◽  
pp. 557-563 ◽  
Author(s):  
Takehiro Okabayashi ◽  
Michiya Kobayashi ◽  
Isao Nishimori ◽  
Takeki Sugimoto ◽  
Saburo Onishi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Fistula Formation

scholarly journals Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 436-441
Author(s):  
K.G. Valikhnovska
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Retrospective Analysis ◽  
Pancreatic Head ◽  
Fistula Formation ◽  
Surgical Interventions ◽  
Periampullary Tumors ◽  
Pancreatic Fistulas

Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

scholarly journals Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094342
Author(s):  
Kate Nong ◽  
Yue Zhang ◽  
Shengyong Liu ◽  
Yue Yang ◽  
Donglin Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Bilirubin Level ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Amylase Level ◽  
Drainage Fluid ◽  
Soft Pancreas ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Potential Risk Factors

Objective To analyse potential risk factors for postoperative pancreatic fistula (POPF). Methods A retrospective study on risk factors for POPF was conducted in patients undergoing laparoscopic pancreatoduodenectomy. Basic characteristics, and preoperative, intraoperative and postoperative patient data were collected and analysed. Results A total of 268 patients were enrolled in this study, including 54 patients with POPF following surgery (POPF incidence, 20.15%). Univariate analysis indicated that patient’s age, body mass index (BMI), preoperative bilirubin level, pancreas texture, and drainage fluid amylase level on day 1 following surgery were associated with POPF. Multiple logistic regression analysis indicated that preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25, and age ≥65 years were independent risk factors associated with POPF. Conclusions For patients with preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25 and age ≥65 years, clinically relevant measures should be taken as early as possible for the prophylaxis of POPF.

scholarly journals Intraoperative pancreatic injury gives rise to severe postoperative pancreatic fistula: Results of a review of unedited videos of the laparoscopic surgical procedures

2018 ◽  
Author(s):  
Yuya Sato ◽  
Kazuyuki Kojima ◽  
Mikito Inokuchi ◽  
Keiji Kato ◽  
Hirofumi Sugita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Surgical Procedures ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Pancreatic Injury ◽  
Postoperative Pancreatic Fistula ◽  
Video Recordings ◽  
Significant Difference ◽  
Laparoscopic Surgical Procedures

Objective To examine risk factors for and causes of severe postoperative pancreatic fistula (sPOPF) after laparoscopic gastrectomy (LG) Summary of Background Data There are few reports on POPF after LG. Methods Between February 2012 and March 2014, we examined 86 patients who underwent LG comparing them with 33 patients who underwent open gastrectomy (OG) for gastric cancer. Risk factors for severe POPF (sPOPF) of Clavien-Dindo grade IIIa or higher were examined. To investigate causes of sPOPF, we reviewed unedited video recordings of laparoscopic surgical procedures. Results sPOPF occurred to 3 patients (3.5%) after LG and 1 patient (3.0%) after OG, indicating no significant difference (p=0.901). Univariate analysis showed no significant risk factors for sPOPF after LG. By reviewing video recordings, all 3 patients with sPOPF after LG had direct pancreatic injury by ultrasonically activated device (USAD) during peripancreatic lymphadenectomy. In 2 of them, pancreas was injured while the contour of pancreas was obscured by bleeding. Durations of drain placement and postoperative hospitalization were longer for patients with sPOPF than for those without POPF or grades I and II POPF (p = 0.003, 0.018; respectively). Conclusions No risk factors for sPOPF after LG could be identified. USAD-induced direct pancreatic injury resulted in sPOPF, which significantly complicated the postoperative clinical course. Direct pancreatic injury can occur whether patient has previously reported risk factors (i.e. male, high BMI, distal pancreatectomy) or not. To prevent pancreatic injury, surgeons should manage hemostasis and keep good surgical field to recognize the contour of pancreas accurately.

Preoperative Psychological Burdens in Patients with Vestibular Schwannoma

2021 ◽  
pp. 000348942110189
Author(s):  
Yufeng Li ◽  
Guo Ran ◽  
Kaizheng Chen ◽  
Xia Shen
Keyword(s):  
Risk Factors ◽  
Psychological Stress ◽  
Vestibular Schwannoma ◽  
Univariate Analysis ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Psychological Burden ◽  
Factors Associated ◽  
Clinically Significant

Objective: To assess preoperative psychological burden in patients with vestibular schwannoma (VS). Methods: A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress. Results: Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress. Conclusion: Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden.

scholarly journals Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Amyna Jiwani ◽  
Tabish Chawla
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
Multivisceral Resection ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Fistula Formation ◽  
Factors Associated

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

Laparoscopic and Open Distal Pancreatectomy: A Comparison of Outcomes

2009 ◽  
Vol 75 (8) ◽  
pp. 671-680 ◽  
Author(s):  
Kelly R. Finan ◽  
Emily E. Cannon ◽  
Eugenia J. Kim ◽  
Mary M. Wesley ◽  
Pablo J. Arnoletti ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Pancreatic Surgery ◽  
Univariate Analysis ◽  
High Volume ◽  
Fistula Formation ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Open Distal Pancreatectomy ◽  
Significant Difference

Laparoscopic (lap) pancreatic surgery has been increasingly reported since its introduction in 1992. A retrospective analysis of consecutive patients undergoing elective lap and open distal pancreatectomy from 2002 to 2007 was performed. Univariate analysis was completed to evaluate perioperative variables. Logistic regression analysis was used to model predictors of postoperative pancreatic fistula. One hundred forty-eight subjects underwent distal pancreatectomy; 98 completed open, 44 lap, and six converted to open. There was no significant difference in the incidence of postoperative morbidity or mortality between the surgical approaches. Decreased operative time (156 vs 200 minutes, P < 0.01), blood loss (157 vs 719 mL, P < 0.01), and length of stay (5.9 vs 8.6 days, P < 0.01) were seen in the lap group. There was no significant difference in the rate of all pancreatic fistula formation (50 vs 46%, P = 0.94) or clinically significant leaks (18 vs 19%, P = 0.97) between techniques. A preoperative biopsy-proven cancer, increasing body mass index, history of pancreatitis, and male gender were significant predictors of having a pancreatic fistula. Lap and open distal pancreatectomy are performed safely at high-volume pancreatic surgery centers. This report provides ongoing support of the feasibility and safety of the lap approach with improved perioperative outcomes and equivalent pancreatic fistula rate.

075 Association between intracranial stenosis and extracranial stenosis seen in stroke patients

2018 ◽  
Vol 89 (6) ◽  
pp. A30.3-A31
Author(s):  
Geetha Guduguntla ◽  
Cheng Ling Ting ◽  
Tarun Jain ◽  
Yash Gawarikar ◽  
Ronak Patel
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Univariate Analysis ◽  
Intracranial Stenosis ◽  
P Value ◽  
Periventricular White Matter ◽  
Chi Square ◽  
Clinically Significant ◽  
Fazekas Scale ◽  
Extracranial Stenosis

IntroductionThe association between intracranial stenosis (ICS) and extracranial stenosis (ECS) using CT angiography (CTA) and the occurrence of ischaemic stroke and TIA has not yet been fully investigated.This study aimed to investigate if there is a clinically significant relationship between ICS and ECS with stroke and its risk factors, including diabetes, hypertension, hypercholesterolemia, atrial fibrillation (AF) and ischaemic heart disease (IHD).MethodsFour hundred and fifteen consecutive patients that presented to Calvary Public Hospital, Bruce were retrospectively analysed, with 158 excluded for incomplete CTA and MRA results. ICS and ECS severity was based on grading used in the WASID and SAMPRISS trials, while the Fazekas scale was used to grade periventricular white matter disease. CTA findings were used to base the presence and absence of stenosis.ResultsICS and/or ECS was present in 80% with ischaemic stroke, 78% with TIAs but comparatively only in 56% of those diagnosed as ‘mimics’ (p<0.05). Univariate analysis demonstrated an association between presence of ICS and AF, hypertension, IHD and diabetes (82%, 73%, 84%, 78%; p<0.001) respectively, while for ECS only with AF, hypertension and IHD (77%, 67%, 81%; p<0.001) respectively. Diabetes was independently associated as single biggest risk factor for ICS. Most steno-occlusive lesions were bilateral for ICS and ECS at 80% and 61%, respectively. There also seems to be an association between the presence of ECS and the presence of ICS, with ECS particularly demonstrating predictive value for ICS (ECS PPV for ICS=0.85, chi-square p-value<0.001).ConclusionThese findings suggest a significant association between the presence of ICS and ECS with the occurrence of ischaemic stroke and TIAs as well as with well-known stroke risk factors. This also indicates that perhaps the underlying pathophysiology for steno-occlusive lesions plays a role in ischaemic stroke and warrants further investigating.

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